Electroconvulsive therapy (ECT) is a medical treatment
that psychiatrists use to treat mood disorders, such as severe depression,
mania, schizophrenia, and other psychiatric and neurological disorders.

ECT is administered under safe and highly controlled
medical circumstances, sometimes with the assistance of an anesthesiologist.
During the treatment and the recovery period, the person's pulse, blood
pressure, heart rhythm and blood oxygen concentration are carefully monitored.

When the ECT is given, a sophisticated machine passes a
precisely controlled electric current through a person's scalp and induces a
seizure throughout the brain. Because the patient has received anesthesia and a
drug that briefly paralyzes the muscles, an observer will notice only small
movements of the patient's fingers, toes and eyelids. However, the seizure
activity will be very apparent on the ECT machine's brain wave monitor, where a
characteristic pattern of waves can be seen. The seizure lasts about a minute
and is followed by a quiet, relaxed state. When the person awakes, he or she is
comfortable but a little disoriented, a problem that resolves within minutes.
After the treatment, the person is given liquids and light food, and he or she
is promptly able to walk around without help.

Most patients receive six to 12 ECT treatments, which
usually are administered three times per week. After these initial ECT
treatments, continued care is essential to prevent return of symptoms. Such
treatment usually involves medications (such as antidepressants or mood
stabilizers) and psychotherapy. Some people, especially those who have not
responded to medications or who cannot tolerate the side effects of medications,
may benefit from receiving further treatment with ECT. For such individuals, ECT
is administered far less frequently (once a month as a maintenance dose, for
example).

How Does ECT work?

Early in the 20th century, scientists discovered that mood
improved in some people with psychiatric illnesses after they had a seizure.
This led to the development of methods by which seizures could be electrically
induced.

Scientists still do not know the exact mechanism by which
ECT produces its benefits. However, they do know that a seizure mobilizes brain
chemicals called neurotransmitters. The effect is that brain cell activity is
changed in much the same way as it is by antidepressant medications and perhaps
by other mechanisms of action as well. However, ECT works more quickly than
antidepressants and is often successful when antidepressants have not worked.
Like many effective treatments in medicine, the effectiveness of ECT continues
to lack an exact explanation, but this does not diminish its value in providing
relief from mental pain and suffering.

What Conditions Does ECT Help?

ECT is highly effective in treating depression. Studies
have shown that 70 percent to 80 percent of people improve after six to 12
treatments, with even higher rates of improvement for people receiving ECT as a
first-line treatment. For most people with depression, however, medications are
the first-line treatment. ECT is an important alternative for those who do not
improve after taking medications, who cannot tolerate side effects of
medications, or who are at high risk of suicide or medical complications of
severe depression.

ECT is also the most effective treatment available for
depression that is accompanied by agitation or psychosis, or that is
characterized by acute and discrete episodes of illness. With psychotic
depression, people cannot distinguish what is real from their unreal thoughts
and perceptions. They may have hallucinations (hearing, seeing or feeling things
that are not there) or delusions (persistent false beliefs, such as thinking
someone is trying to hurt them). Catatonia (in which a person is immobile and
does not react to his or her surroundings) also is very responsive to ECT.

Although used less commonly, ECT also can effectively
treat severe mania (in which excitement, sleeplessness, impulsiveness and severe
irritability threaten the well-being of the individual and those around him or
her). Symptoms of schizophrenia, particularly psychosis, also may respond to ECT
when medications have not been helpful. Recent studies show that ECT can be
effective in other medical and neurological disorders, such as Parkinson's
disease or seizures (caused by neurological disease) that cannot be stopped by
treatment with medications.

What Are the Side Effects of ECT?

ECT is a remarkably safe treatment that is provided under
carefully controlled medical conditions. As with any medical treatment, people
who receive ECT differ considerably in the extent to which they experience side
effects. However, a thorough medical evaluation before the start of ECT and
extensive monitoring at the time of ECT reduce the chance of medical
complications. Occasionally, ECT results in irregularities in heart rate or
rhythm, but these are usually mild and short lasting. Very rarely, ECT can
result in serious medical complications, and there are the potential
complications of general anesthesia, which are explained to the patient as a
part of the consent process (see
below).

Immediately after treatment, some people experience
headache, mild nausea or muscle soreness. Confusion is another common side
effect that goes away in a few minutes to a few hours, depending on the person.
Problems with memory also occur but improve after the completion of ECT. Some
patients will have spotty gaps in memory of events that occurred in the weeks
before the course of treatment. More frequently, people who receive ECT will
have trouble remembering events immediately before and during the day of each
treatment. Their recall of the weeks from the beginning to the end of the
treatments will be hazy. This happens because ECT temporarily interferes with
the storage of new memories. However, studies show that ECT does not impair
future learning. In fact, because depression and other mental illnesses
interfere greatly with concentration and memory, many people will report
improved mental functioning after ECT.

Can ECT Be Given Against a Person's Will?

As with all medical procedures, ECT requires informed,
written permission (consent). There are protections built into state law, which
vary from state to state. A psychiatrist must explain the treatment and what to
expect as well as the risks and benefits of ECT compared with other treatment
options. Any patient who gives written permission for ECT can withdraw that
consent at any time, thereby ending the treatment. The American Psychiatric
Association (APA) recently updated its recommendations for obtaining written
consent for ECT. In addition to the need for written permission, key elements of
the APA consent recommendations include the importance of a careful explanation
of all aspects of the treatment and the patient's right to refuse ECT.

When a person is too ill or confused to provide in-formed
consent, specific state laws and regulations outline the procedure that must be
followed. Typically, this involves having a judge decide whether the treatment
should occur, or a family member or other individual appointed by the court as a
temporary guardian who can give or withhold consent on the patient's behalf.

ECT Has Been Portrayed as Cruel and Barbaric. Is It?

Decades ago, when ECT was first used to treat psychiatric
illnesses, effective short-acting anesthesia and muscle-relaxing medications
were not available. Consequently, ECT would produce a violent grand mal seizure
in which patients could be injured. In "One Flew Over the Cuckoo's Nest," the
1975 movie starring Jack Nicholson that was set in a psychiatric hospital in
1950s, ECT was portrayed as a painful and excessive treatment. Consequently,
many people still think of ECT as barbaric.

Today, however, people are given a short-acting
anesthetic, which puts them to sleep for several minutes, before they receive
ECT. They also receive muscle-relaxing medication so the brain seizure does not
cause major muscle spasms in the rest of the body. The effect of the treatment
is hardly visible beyond brief contractions of the eyelids, fingers and toes. In
addition, substantial scientific evidence indicates that ECT does not cause any
damage to the brain, nor does it increase a person's risk of developing a
seizure disorder. Unfortunately, many old-fashioned ideas about ECT persist,
frightening people whose mental illness already causes them great distress.

If your physician or psychiatrist recommends ECT, don't
rule it out because of outdated stereotypes. The truth is that ECT works rapidly
and is extremely effective. As administered today, ECT is also quite safe and
sometimes has fewer side effects than medications. Get the facts about your
treatment options, and ask your psychiatrist about the benefits and safety of
ECT.